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Montgomery County Fire & Rescue Training Academy
• A disease caused
by the growth of
disease causing
microorganisms in
the body.
• May or may not be
contagious
Four Types of Infectious Agents
Bacteria
• Virus
• Fungus
• Parasites
•
Smaller than
red blood
cells
Live on their
own, outside
body cells
Antibiotics
usually
effective
Smaller than bacteria
Herpes Simplex
Must penetrate and inhabit
body cells to survive
Hard to kill without
harming healthy cells
Solution:
Immunization
Measles
Herpes Zoster
(Shingles)
Immunization
prevents a virus
from entering the
body cells
Basically, the ONLY
way to prevent viral
infection
Mold
Yeast
Intestinal
Tapeworm
Lice
INFECTIOUS DISEASE
• Communicable
• Transmitted readily from one
person to another either
directly or indirectly.
• Or from animal to human (zoonotic)
• Mosquitoes , Bats, Rabid Animals
Chain of Infection
is required for a person to become infected
Infectious
Agent
Susceptible
Reservoir
Host
Means of
Entry
Mode of
Transmission
Means of
Exit
EXPOSURE/ROUTES OF
INFECTION for F/R Personnel
•Percutaneously
•Mucocutaneously
•Airborne
PERCUTANEOUSLY
• Through the skin or any situation
where the patient’s blood may enter
an open wound.
• i.e.... Needle Stick
MUCOCUTANEOUSLY
• Across the mucus membranes, patient’s blood
or body fluids come in contact with the care
providers:
• Eyes
• Nose
• Mouth
AIRBORNE INFECTION:
Droplet infection,
transmitted by
inhaling droplets from
infected carrier by
coughing, sneezing,
or talking
HIV attacks the
body’s immune
system, making the
body vulnerable to
opportunistic
diseases.
While HIV is fatal, infected persons
usually die from the opportunistic
diseases that overwhelm the body.
•
•
•
•
•
Pneumonia
Tuberculosis (TB)
Toxoplasmosis (protozoan infection)
Some Cancers
Diarrheal Disease
HIGH- RISK HIV PATIENTS
 Homosexual Males
 Users of Injectable Drugs
 Sexually Promiscuous
Babies born of HIV mother
AIDS
Late stage HIV
disease, when
opportunistic
diseases develop

 May take years to
develop
ROUTE OF INFECTION
•
HIV is a blood borne disease and:
• Semen, Cervicovaginal Fluid, Breast Milk
•
Saliva has not been discounted or proven, but the
HIV virus is found in it, although in small amounts.
• HIV infected blood has approximately 1
thousand viral particles per milliliter (ml.).
INCUBATION
PERIOD
Disease may develop in a matter of
months or take several years.
Antibodies usually detected by a blood
test 2 weeks to 3 months after infection.
May develop later in a small percentage of persons
Prognosis:
HIV/AIDS has become more manageable.
It is a chronic disease for many people, but
still has no definite cure or vaccine
Illness, disability, and except in
rare instances,
DEATH!
• Now Hepatitis D, E, F & G
• Highly contagious
• Usually transmitted via the fecal - oral route
• Outbreaks of type A hepatitis often occur
after people have eaten seafood that came
from contaminated water.
• Common exposures occur in care facilities
such as convalescent / nursing
homes, mental institutions, day
care centers and schools
Incubation
• 15 to 50 days, depending on dose
• Average of 28 to 30 days
PROGNOSIS
• In most patients with HAV, liver cells eventually
regenerate with little or no residual damage.
• Patients usually recover readily, with a life-long
immunity to hepatitis type A, but not type B or type C
• Old age & serious medical conditions (CHF, severe
anemia, diabetes) make complications more likely.
Description:
A generalized
inflammation of
the liver
caused by
HBV that
attacks and
destroys liver
cells.
HIGH-RISK PATIENTS
•
•
•
•
Homosexual Males
Users of Injectable Drugs
Sexually Promiscuous (Multiple Partners)
Prostitutes (sex for money or drugs)
– (homosexual and/or heterosexual)
•
Babies born/breast feeding HBV mother
NOTE: Some blood bank statistics report as
many as 80% of homosexual males have been
exposed to HBV
Route of Infection:
• Classified as a blood borne disease,
considered to be spread by contact with
body fluids such as:
• Blood
• Saliva
• Semen
• Vaginal Fluid
Note: HBV has approximately 1 billion viral particles per
milliliter of blood, making HBV much more infectious
than HIV and more difficult to kill on surfaces
RECOMBIVAX VACCINE
Available to all Montgomery County Fire &
Rescue personnel, career and volunteer,
through Fire Rescue Occupational Medical
Services (FROMS) at no charge.
INCUBATION PERIOD:
45 - 180 days
[6-weeks to 6-months]
with the average being 60-90 days.
PROGNOSIS:
• If detected early, prognosis is good.
Although not usually fatal, it causes
many liver diseases, such as
cirrhosis and causes up to 80% of all
liver cancer.
• Despite the fact that Hepatitis B is
curable, it still causes about 200
deaths to HEALTHCARE WORKERS
each year.
Thought to be leading cause of hepatitis
resulting from blood transfusions.
 NOT transmitted efficiently by sexual contact
Primarily a BLOODBORNE disease:
Single needle stick can contaminate
 Greater likelihood of becoming a chronic carrier of HCV after
infection.
 No current vaccine
 Immune globulin (IG) following exposure to HCV provides
temporary, passive immunity.
Transmitted By Mosquitoes
A bacterial infection that infects via the
respiratory system
 Usually settles in the
lower 2/3 of the lungs,
where ventilation
(exchange) is minimal.
 May spread to lymph
nodes and other areas:
brain, meninges, kidneys,
adrenal glands, stomach,
intestines, peritoneum
and bones.
High-Risk Persons
 Recent Immigrants
 Persons living in overcrowded /
poverty conditions (homeless).
 Persons with low immunity
 HIV, Cancer, Long term steroid use, Elderly
 Alcohol/Drug abusers
High-Risk Persons
HIV Infected persons
Correctional Inmates
Long-term care facility residents
Close contact of TB patients
Substance Abusers
High-Risk Persons
 Foreign-born individuals from
countries with high incidence of TB
 Health-care workers providing
care to high-risk groups
 Persons with previous Hx of TB
 People in Poverty: Crowded
conditions, poor sanitation, poor
nutrition
Multi-Drug Resistant TB
Usually found only in highdensity population areas
Common in DC, New York
PROGNOSIS:
After several weeks, otherwise healthy
patients may develop a specific immunity,
encapsulating the TB bacteria in granular
tumors.
These granulomas usually remain dormant
for life, but are capable of producing the
disease again at any time.
If untreated, 8-20% of TB patients will
develop serious diseases.
Route of Infection:
Droplet infection,
transmitted by
inhaling droplets
from infected
carrier by
coughing,
sneezing, or
talking
EMERGENCY CARE:
A-B-C, O2 as needed
NIOSH approved face
masks for all EMS
personnel
Disposable surgical
masks on:
 Patient, unless on O2
 Family members riding
in the ambulance
Notify hospital of
potential TB patient so
they may prepare
respiratory isolation.
Ventilate back of
ambulance by opening
windows
 TB Bacillus is very
sensitive to light and air.
DESCRIPTION:
Inflammation of the membranes of the
brain and spinal cord (meninges).
Meningitis may be caused by
– Bacteria
– Virus
– Other organism that reaches the meninges by:
 Bloodstream
 Lymphatic System
 Trauma (open wounds)
 From adjacent sinuses
Patients at High-Risk
•
Persons in overcrowded / poor living
conditions
•
•
•
•
•
Homeless
Schools & Colleges
Institutions
Military Barracks
Persons with low immunity
•
HIV, Cancer, Long term use of steroids
VERY SERIOUS IF:
•
•
Petechiae (small, purple, spider-like hemorrhage spots on skin)
Signs of Infection
•
•
•
•
•
Chills
Low Or Dropping B/P
Rapid, Shallow Respirations
Rapid Pulse
Purpura - purple spots that don’t turn
white when pressed
Route of Infection
•
DROPLET
•
Transmitted by inhaling droplets
from coughing, sneezing or talking
by the infected carrier
Saliva Exchange
•
Prognosis:
•
•
•
•
Favorable with PROMPT diagnosis &
treatment
May leave long term neurological
disorders if diagnosis and/or treatment
are delayed.
Potentially fatal
Most serious in
 Children (especially neonates)
 Elderly
EMERGENCY CARE:
A-B-C, O2 as needed
NIOSH approved face
masks for all F/R
personnel
Disposable surgical
masks on:
 Patient, unless on O2
 Family members riding
in the ambulance
Notify hospital of
potential meningitis
patient so they may
prepare respiratory
isolation.
Ventilate back of
ambulance by opening
windows
Best Defense Against Infection:
Body Substance Isolation
Eliminates the Means of Entry
Infectious
Agent
Susceptible
Reservoir
Host
Means of
Entry
Mode of
Transmission
Means of
Exit
Body Substance Isolation
Consider ANY patient’s blood or body fluid to
be infectious
GLOVES : All fire/Rescue personnel MUST
don appropriate protective gloves PRIOR to
arrival at the scene of any EMS incident
 Anytime
you could possibly contact body fluids
 During extrications, wear under heavy gloves
 While decontaminating &/or disinfecting
MASKS
Wear in any situation in which blood or body
fluids could be splashed in your face, or droplet
infection is suspected.
With a potential or known TB or meningitis
patient, put a surgical mask on the patient.
Mouth-to-mouth ventilations should not be
performed, rescuer should use a pocket mask
with a one-way valve
EYE PROTECTION
Wear any time blood
or body fluids could
be splashed in your
eyes, such as active
bleeding, vomiting or
mentally disturbed
patients (spit)
GOWNS
Indicated for situations
such as childbirth or
uncontrolled bleeding
Blood-soiled gowns and/or
other contaminated
clothing is considered
infectious.
PROTECT BROKEN SKIN
Cuts, abrasions, insect bites, etc.
should be protected with a Band-Aid
or a dressing.
SHARPS
• IV needles, etc. are to be placed in a sharpesafe container as soon as possible
• NEVER leave on seat, litter or squad bench
• NEVER leave ANY contaminated materials or
sharps at the scene or patient's residence
• NEVER recap a used needle: put it in a sharps
container.
WASH YOUR HANDS !!!
• With disinfectant or anti-bacterial soap
as soon as possible after every call.
• At the hospital
• After handling items soiled
with blood or body fluids
• Wash your hands when you take the
gloves off
Cleaning/Decontamination
Procedures
All non-disposable equipment used in
patient care should be cleaned after each
use
Any equipment in contact with body fluids
needs to be cleaned and disinfected
 Wear gloves and other protective devices as
needed
 Clean with detergent, etc. To remove dirt, blood,
etc. You cannot disinfect a surface that is dirty
Cleaning & Decontamination
After cleaning, DISINFECT the equipment
by using one or more of the following
agents:
 A freshly mixed solution of 1 part bleach to 9
parts of water
oFor non-metallic surfaces
oEspecially effective on fresh (non-dry) blood spills
oContact time: 20-30 minutes for high level
disinfection, followed by clear water rinse & air
dry
Cleaning & Decontamination
Disinfectant Soaps:
 May be used on most equipment where a high level
disinfection is not necessary
70 % Isopropyl alcohol:
 Contact time : 5-30 minutes
 Is NOT EFFECTIVE in presence of blood or dirt
 Good for use on skin, metals, and electrical equipment
3 % Hydrogen Peroxide
 Not recommended for high-level disinfection
 Good for removing blood on fabrics
DISPOSABLE ITEMS
All sharps MUST BE
transported and
disposed of in a
approved Sharps
container………ONLY!
DISPOSABLE ITEMS
Items such as blood soaked sheets should be placed
in a red BIOHAZARD impervious plastic bag &
transported to the hospital with the patient.
 DO NOT throw the sheets in the hamper
Each station must have an
approved bio-hazard waste
container. They are disposed of by
an approved bio-hazard contractor
EXPOSURE
TO
INFECTIOUS
DISEASE
WHAT IS NOT A
PERCUTANEOUS EXPOSURE ?
Blood or body fluids on
equipment
Blood or body fluids on
clothing with intact skin
underneath
Blood or body fluids on
intact skin unless it is a
LARGE quantity of blood &
a prolonged exposure (i.e.
greater than 20 mins)
BLOODBORNE
diseases CANNOT be
transmitted by talking
to or touching an
infected person
EXPOSURE PROCEDURE
Immediate Self-Care: Percutaneous
Wipe off excess blood from skin and
scrub area with soap & water or
antiseptic hand cleaner for 5-10
minutes.
If the wound is bleeding, allow it to
bleed to remove any contaminants.
If soap & water are not immediately
available apply your issued
Antiseptic Handwash from your
fanny pack until proper disinfecting
measures can be taken.
EXPOSURE PROCEDURE
Immediate Self-Care: Mucocutaneous
Flush eye(s) thoroughly for 15 minutes
and/or rinse mouth with saline or
water.
As soon as patient care allows, or
upon arrival at the hospital, wash your
hands and the wound thoroughly.
Wash face as necessary.
Have emergency department physician
assess and provide treatment for
wound as needed.
EXPOSURE PROCEDURE
Immediate Self-Care
Access the DRFS-STP Infectious
Disease web site and click on
“Exposure” for the current, complete
exposure procedure.
http://www.montgomerycountymd.gov/content/firerescue/
psta/stp/infectiousdisease04/ExposeF.asp
FOLLOW UP PROCEDURE
• Notify your Supervisor immediately
• Document the circumstances concerning the
exposure.
• Career personnel must follow Policy &
Procedure #807.
• If you were not on the transporting unit,
regardless of the type of exposure, report to
the hospital ED for the appropriate treatment.
FOLLOW UP PROCEDURE
• For both Career and Volunteer personnel:
notify Fire & Rescue Occupational Medical
Section (FROMS) at 240-777-5185 as soon as
possible following an exposure.
• If it is determined that a patient that was
treated has a communicable disease, the
EMS section of the DFRS will notify the
individuals departments.
FOLLOW UP PROCEDURE
It is extremely important that the run
sheets be left for all transported patients
with the Emergency Department as well
as properly listing all personnel that
were involved with the incident on the
MAIS report & FIREHOUSE!!!!
QUESTIONS
• Contact the On-Duty EMS captain.
• Reference the Website on Quicklinks